Despite the existence of effective treatments, mental health care disparities exist in the availability, accessibility, and quality of services for racial and ethnic minority groups. People living with serious mental complaints often resist engaging in treatments and experience high rates of dropout; poor engagement can lead to worse clinical outcomes. Addressing the complex mental health care needs of racial and ethnic minorities warrants considering evidence-based strategies to help reduce disparities. This systematic review sought to provide an analysis of published literature about the barriers and effective strategies in identifying and treating minority patients with mental health disorders. The practice-focused question of this systematic review was: What are the barriers and effective strategies to identification and treatment of mental health disorders among minority populations. This project was guided by PRISMA and SQUIRE guidelines and Fineout-Overholt and Melnyk’s appraisal form, comprising 11 studies published between 2014 and 2019, identified through Thoreau, Cochrane, CINAHL with Medline, EBSCO, and ProQuest, SAMHSA and PubMed databases. The systematic review results recommend intervention strategies such as integrated/collaborative care, workforce diversity, providers in minority neighborhoods, improving providers’ cultural skills, and stigma reduction to help reduce mental health care disparities. These findings are significant to lowering the gap in practice and can be used by the entire health care system to improve mental health care, thereby leading to a positive social change. Implementing these strategies would benefit patients, families, their communities, and the entire health care delivery system.

Introduction: Despite advances in evidence-based smoking cessation approaches, quit rates in people with mental health conditions who smoke have not increased over the past decade. This research explored the role of family or peers in promoting smoking cessation in this population, using three specific aims; 1) examine the association between family or peer views on tobacco use and smoking cessation, 2) identify pathways through which family or peer factors influence smoking cessation, and 3) identify social barriers and facilitators to seeking cessation support when quitting. Methods: We used data from the Population Assessment of Tobacco and Health Study and collected qualitative data from people with mental health conditions who currently smoke or quit within the last five years. Data were analyzed using logistic regression modeling, structural equation modeling, and rapid qualitative analysis. Results: Having family or peers with positive or neutral views on tobacco use significantly reduced the odds of quitting smoking. Higher intentions to quit and changes in smoking behavior mediated the relationship between supportive family or peer behaviors and quitting smoking. Quitting together and encouragement from family or peers were perceived as supportive, while nagging the individual undermined quitting success. Except for individuals who regarded autonomy highly or were not ready to stop smoking, stronger social relationships and tailored support increased willingness to involve family members in cessation interventions. Conclusions: Supportive family or peer attitudes and behaviors can positively influence smoking cessation in people with mental health conditions who smoke. Ways to identify ideal family or peer support partners to involve in cessation interventions are proposed.

No description available.

Call number: LD2668 .T4 1985 B87 / Master of Arts

Objective: To expand the access to culturally relevant hearing health services in a rural U.S. border community with already limited healthcare resources, community health workers (Promotoras de Salud) were trained to provide peer-facilitated hearing education classes. Design: A specialized three-phase training process for community health workers was developed, implemented, and evaluated. The training process included: 1) Focus groups with community health workers and residents from the community to raise awareness of hearing loss among community health workers and the community; 2) A 3-hour workshop training to introduce basic topics to prepare community health workers to identify signs of hearing loss among community members and utilize effective communication strategies; and 3) A 24-hour multi-session, interactive training over 6 weeks for community health workers who would become facilitators of educational and peer-support groups for individuals with hearing loss and family members. Study Sample: Twelve Spanish-speaking local community health workers employed by a federally qualified health center participated in a focus group, 12 received the general training, and four individuals with prior experience as health educators received further in-person training as facilitators of peer-education groups on hearing loss and communication. Results: Community health workers increased their knowledge base and confidence in effective communication strategies and developed skills in facilitating hearing education and peer support groups. Through case study practice, community health workers demonstrated competencies and applied their learning to specific situations related to effective communication with hearing loss, family support, assistive technology, use of hearing protection, and making referrals for hearing health care. Needs were identified for ongoing training in the area of assistive technology and addressing situations of more severe hearing loss. Conclusions: It is feasible to train community health workers to begin to address hearing loss and facilitate peer health education and support groups for individuals with hearing loss and their family members. In efforts to increase access to audiologic services in rural or hard-to-reach areas, application of the community health worker model with a partnership of audiologists deserves further consideration as a viable approach.

Of the 2,858 licensed competitive road cyclists in Texas, female cyclists only account for 12%. The gender disparity in participation numbers suggests possible underlying barriers to entry, recruitment, and retention of female athletes compared to that of male cyclists. The current study sought to understand such issues by exploring the entirety of the competitive road cycling experience of female cyclists in Texas. To accomplish such a task, the current study utilized a mixed methods design consisting of content analysis, interviews, and an online survey. Integrating methods allowed for a more comprehensive understanding of the individual as impacted by structural, socio- cultural, and individual factors and further reveals how such factors are interrelated and mutually reinforcing. Results revealed how socio-culturally informed gendered attitudes and norms heavily impact structural policies, rules, and regulations within competitive cycling. Subsequently, structural factors influenced individual choices, attitudes, and behaviors. Further, results emphasized that individuals are complex beings, and although shaped by their environment, embody personal agency, resistance, and coping. Individual decisions, attitudes, and desires subsequently shaped socio-cultural norms and structural processes. Finally, structural reform strategies are suggested to help increase female participation and retention rates within competitive road cycling in Texas. / text

The medical profession in recent decades has made culture and cross-cultural competence an issue for patient – physician relationships. Many in the profession attribute the necessity of cross-cultural competence to increased diversity, globalization, and health disparities; however, a historical analysis of medicine indicates that culture’s relevancy for health care and outcome is not new. The rise of clinics, which can be traced to 17th century France, the professionalization of physicians in 18th century U.S., and the civil rights movement of the 20th century illustrate that medicine, throughout its history, has grappled with culture and health. While medicine has a history of discussing cultural issues, the profession has not defined culture cogently. Medicine’s ambivalence in defining culture raises questions about how effectively medical educators prepare residents to be cross-culturally competent. Some medical educators have expressed that many didactic and experiential efforts result in stereotyping patients. Definitions of culture and their impact on stereotyping patients are the central problems of this study. Specifically, this study hypothesized that cultural beliefs impact ones willingness to accept stereotypes. Thus, this study sought to learn how faculty members and residents define culture. Faculty members also were compared to residents to glean the impact of cross-cultural education. This study used an explanatory mixed method design where quantitative and qualitative methods work complementarily to examine a complex construct like culture. A valid and reliable survey provided quantitative data to compare the two groups, while open-ended questions and interviews with faculty members provided context. The statistical results reveal that faculty members and residents share a philosophy of culture; however, when the two groups’ definitions are contextualized, they have many different beliefs. Differences also emerged with respect to predictability; cultural beliefs predict stereotyping among residents, but not faculty members. Faculty members attribute these differences to experiences, while residents believe that they do not learn about culture during their professional education.

Cigarette smoking is the leading cause of preventable disease and is the cause of nearly 1 in 5 deaths in the United States. The prevalence of smoking has had a leveling off effect after many years of significant decline. Certain subgroups of the population, such as those with low income and certain illnesses, continue to smoke at disproportionately high rates. Reasons for these disparities in smoking rates are complex. Developing a better understanding of the issues related to persistent smoking particularly for those with medical illness and limited access to cessation resources can help focus interventions to help these high risk smokers quit. This dissertation includes a systematic review of the literature associated with hardcore smoking; an analysis of the reliability and validity of a self-efficacy instrument in a sample of low-SES, medically ill smokers; and the results of a cross-sectional, non-experimental study exploring the relationship between smoking-related factors and planning to quit in a sample of medically ill smokers. A sample of 70 current and recent smokers was surveyed at a free clinic. Quitting self-efficacy was measured using an instrument not previously tested in a rural, medically ill sample. Modifications to the survey were made based on qualitative interviews with smokers and a single question measuring self-efficacy was also tested. There was a high correlation among the self-efficacy measures (Spearman’s rho .99, p < .001) and between the longer instrument and the single question (Spearman’s rho .65, p < .001). Each measure demonstrated acceptable reliability and validity. In the study exploring potential factors associated with planning to quit, the number of prior quit attempts and confidence to quit explained 43% of the variance in those planning versus not planning to quit. Providing interventions focused on increasing confidence and experience with quit attempts can be effective in promoting a plan to quit in this group of smokers who, because of their medical illness, can benefit significantly from cessation. Research is needed to explore cessation outcomes when employing these targeted interventions with medically ill smokers in rural areas.

The size of the Mexican-origin population in the United States means that its health patterns have important implications for the country’s overall population health. Understanding how this population is woven into the country’s complex social patterning of health is critical to understanding current social disparities in health. Drawing on a health disparities perspective and nationally representative datasets, this dissertation addresses key gaps in the social demographic literature on the health of the Mexican-origin population through three empirical chapters that examine how multiple measures of cardiovascular health are distributed across diverse social status and temporal configurations. I first examine how the obesity epidemic has unfolded across multiple temporal (age, period, and cohort) and social dimensions (gender, nativity, and race) for the Mexican-origin population. I find that period rather than cohort forces have shaped the rise in obesity among the Mexican-origin population. Furthermore, the pronounced group differences in obesity prevalence have remained stable across periods and cohorts, with the exception of a growing nativity gap among Mexican-origin women, among whom obesity has increased faster for U.S.-born individuals compared with foreign-born individuals. I next address the intersection of two additional temporal and social determinants of health: duration of residence in the United States and educational attainment. Building on research documenting a weak relationship between education and health for Mexican immigrants, I assess whether duration of U.S. residence strengthens this association. The patterns vary by outcome, but generally indicate that negative education gradients in health are more pronounced for long-term Mexican immigrants than for recent Mexican immigrants and that the education gradients of long-term Mexican immigrants resemble those of U.S.-born Whites. I then engage the literature linking acculturation to poor health among Mexican immigrants. Acculturation models of immigrant health have come under critique for ignoring the structural determinants of health. I engage in this debate by using segmented assimilation theory—which emphasizes the role of structural factors—to examine whether education conditions the association between acculturation and health. I find support for the idea that the detrimental influence of acculturation on cardiovascular health is concentrated among Mexican immigrant adults with low levels of education. / text

Breast and cervical cancer disparities among Hispanic and American Indian women are a significant public health problem. Breast cancer is the most common neoplasm among Hispanic women. Cervical cancer has a higher incidence and mortality among Hispanic women compared to non-Hispanic White women. Breast cancer detection often comes late for American Indian women and breast cancer survival for this population is relatively poor. Hispanic and American Indian women who reside in rural areas of Arizona are especially at-risk of non-participation in breast and cervical cancer screening programs. This dissertation utilized data from two sources: a health-education intervention trial designed to increase mammography screening among women living in a rural area along the U.S.-Mexico border of Arizona and survey data from multiple years of the Arizona Behavioral Risk Factor Survey (BRFS) focusing on breast and cervical cancer screening self-reported behaviors. The purpose of the dissertation research was to identify factors associated with cancer screening behaviors among Hispanic and American Indian women that reside in rural Arizona settings. Hispanic women who participated in the promotora-based educational intervention program were more likely to report receiving a mammogram at the followup compared to women who did not participate in the program. Results from both the baseline community survey and the BRFS showed that Hispanic women who received prior recommendations from a clinician to get both mammography and Pap smear were more likely to report they received a mammogram within the past year and a Pap smear within the past three years. Rural Hispanic and American Indian women reported lower rates of ever having had breast and cervical cancer screening compared to their urban counterparts. Breast and cervical cancer screening use in these populations can potentially be increased with at least two strategies. First, clinician recommendation of both mammograms and Pap smears and opportunistic screening during regular clinic visits may increase breast and cervical cancer screening coverage. Secondly, culturallyappropriate interventions that utilize promotoras or lay health advisors could increase screening rates. In conclusion, Hispanic and American Indian women that reside in rural areas of Arizona, whether throughout the State or along the U.S.-Mexico border, are two underserved populations in Arizona with low rates of breast and cervical cancer screening that need to be addressed in order to reduce the burden of cancer in these populations.